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Titolo:
Analysis of risk factors for the development of GVHD after T cell-depletedallogeneic BMT: Effect of HLA disparity, ABO incompatibility, and method of T-cell depletion
Autore:
Keever-Taylor, CA; Bredeson, C; Loberiza, FR; Casper, JT; Lawton, C; Rizzo, D; Burns, WH; Margolis, DA; Vesole, DH; Horowitz, M; Zhang, MJ; Juckett, M; Drobyski, WR;
Indirizzi:
Med Coll Wisconsin, Froedtert Mem Lutheran Hosp, BMT Proc Labs, Dept Med, Milwaukee, WI 53226 USA Med Coll Wisconsin Milwaukee WI USA 53226 pt Med, Milwaukee, WI 53226 USA Med Coll Wisconsin, Froedtert Mem Lutheran Hosp, BMT Proc Labs, Dept Pediat, Milwaukee, WI 53226 USA Med Coll Wisconsin Milwaukee WI USA 53226 Pediat, Milwaukee, WI 53226 USA Med Coll Wisconsin, Froedtert Mem Lutheran Hosp, BMT Proc Labs, Dept Radiat Oncol, Milwaukee, WI 53226 USA Med Coll Wisconsin Milwaukee WI USA 53226 Oncol, Milwaukee, WI 53226 USA Med Coll Wisconsin, Froedtert Mem Lutheran Hosp, Hlth Policy Inst, Milwaukee, WI 53226 USA Med Coll Wisconsin Milwaukee WI USA 53226 y Inst, Milwaukee, WI 53226 USA Childrens Hosp Wisconsin, Milwaukee, WI 53201 USA Childrens Hosp Wisconsin Milwaukee WI USA 53201 , Milwaukee, WI 53201 USA
Titolo Testata:
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
fascicolo: 11, volume: 7, anno: 2001,
pagine: 620 - 630
SICI:
1083-8791(2001)7:11<620:AORFFT>2.0.ZU;2-L
Fonte:
ISI
Lingua:
ENG
Soggetto:
BONE-MARROW TRANSPLANTATION; VERSUS-HOST DISEASE; CHRONIC GRAFT; IDENTICAL SIBLINGS; CYTOMEGALOVIRUS-INFECTION; IMMUNOGLOBULIN-SYNTHESIS; IMMUNE RECONSTITUTION; UNRELATED DONORS; VIRUS IMMUNITY; CMV DISEASE;
Keywords:
bone marrow transplantation; T cell depletion; graft-versus-host disease; ABO compatibility; CMV serostatus;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
69
Recensione:
Indirizzi per estratti:
Indirizzo: Keever-Taylor, CA Med Coll Wisconsin, Froedtert Mem Lutheran Hosp, BMT Proc Labs, Dept Med, 9200 W Wisconsin Ave, Milwaukee, WI 53226 USA Med Coll Wisconsin 9200 W Wisconsin Ave Milwaukee WI USA 53226
Citazione:
C.A. Keever-Taylor et al., "Analysis of risk factors for the development of GVHD after T cell-depletedallogeneic BMT: Effect of HLA disparity, ABO incompatibility, and method of T-cell depletion", BIOL BLOOD, 7(11), 2001, pp. 620-630

Abstract

Multivariate analysis was performed to determine the independent factors affecting the risk of acute GVHD (aGVHD) grades II to IV and extensive chronic GVHD (cGVHD) and the rate of survival in 481 recipients of T cell-depleted (TCD) marrow allografts who received transplants at a single center between 1991 and 2000. All patients received grafts partially depleted of CD3(+) T cells by complement-mediated lysis using 2 narrow-specificity monoclonal antibodies (MoAbs), T10B9.1A-31 (n = 400) or Muromonab-Orthoclone OKT3 (n= 81). Factors considered in the analysis included patient/donor sex, age,cytomegalovirus (CMV) status, and ABO blood group along with T-cell dose, disease and disease status, donor relationship, HLA antigen (Ag) mismatch (b7M), growth-factor use, anti-thymocyte globulin use, year of transplantation, and the MoAb used for TCD. The results showed an association of HLA MM with an increased relative risk (RR) of aGVHD for recipients of grafts fromrelated donors that were greater than or equal to2 Ag MM (n = 73, RR = 2.09, P =.005), matched unrelated (UR) donors (n = 130, RR = 1.98, P = .004), and greater than or equal to2 Ag Mr I UR donors (n = 34, RR = 2.68, P = .003) compared with the baseline matched-sibling group (n = 121). INTO increased risk of aGVHD was seen for 0 to 1 Ag MM family donors (n = 24) or 1 Ag MM UR donors (n = 99). aGVHD risk was increased with minor, but not major ormajor-minor, ABO disparity (RR = 2.0, P =.003) compared with that of ABO-identical pairs. We found less effective TCD and resultant higher T-cell dose for recipients of grafts that were T cell depleted using OKT3. However, the use of OKT3 and not the T-cell dose was associated with increased aGVHD risk (RR of 1.84, P = .001). Increased risk of extensive cGVHD was associated with patient age of > 20 years (RR = 2.2, P < .0001) and with CMV status(positive patient/negative donor, RR = 1.9, P = .002). Decreased survival was associated with older age (> 20 years), a greater than or equal to2 Ag MM related donor, a 1 or greater than or equal to2 Ag MM UR donor, risk group, and a CMV positive patient/-negative donor pair. There was no difference in survival for 0 to 1 Ag MM related or matched UR donors compared with the baseline group. These data indicate that there are quantitative as well as potential qualitative differences in outcome depending on the TCD method. Expected and unexpected risk factors for GVHD and survival were associated with partial TCD. Our data support the consideration of ABO match in donor selection, the preferential selection of CMV positive donors for CMV-positive recipients, and the acceptance of 1 but not greater than or equal to2 Ag HLA MM donors.

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Documento generato il 04/07/20 alle ore 12:22:51